Orthodontic BenefitsPosted 12/12/12; Modified 05/22/13

Orthodontic benefits can be complicated, but to simplify the benefit for your ease of use, the chart below can explain exactly what is covered, not covered and what is all inclusive. If you have questions, please contact HP Administrative Services LLC at 1-405-416-1800.

Description

Benefit Clarification

D8010

Limited orthodontic treatment of the primary dentition

Covered and can bill separately

D8020

Limited orthodontic treatment of the transitional dentition

Covered and can bill separately

D8030

Limited orthodontic treatment of the adolescent dentition

Covered and can bill separately

D8040

Limited orthodontic treatment of the adult dentition

Covered and can bill separately

D8050

Interceptive orthodontic treatment of the primary dentition

Covered and can bill separately

D8060

Interceptive orthodontic treatment of the transitional dentition

Covered and can bill separately

D8070

Comprehensive orthodontic treatment of the transitional dentition

Covered and All Inclusive

D8080

Comprehensive orthodontic treatment of the adolescent dentition

Covered and All Inclusive

D8090

Comprehensive orthodontic treatment of the adult dentition

Covered and All Inclusive

D8210

Removable appliance therapy

Covered and can bill separately

D8220

Fixed appliance therapy

Covered and can bill separately

D8660

Pre-orthodontic treatment visit

Covered and can bill separately

D8670

Periodic orthodontic treatment visit

Not covered

D8680

Orthodontic retention

Not covered

D8690

Orthodontic treatment

Covered and can bill separately

D8691

Repair of orthodontic appliance

Covered and can bill separately

D8692

Replacement of lost or broken retainer

Covered and can bill separately

D8693

Re-bonding or re-cementing; and/or repair, of fixed retainers

Covered and can bill separately

D8999

Unspecified orthodontic procedure, by report

Each claim will be reviewed for coverage. Provide written description of dental necessity